Provider Demographics
NPI:1174699391
Name:CREELMAN FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:CREELMAN FAMILY PRACTICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CREELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-757-0027
Mailing Address - Street 1:712 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2212
Mailing Address - Country:US
Mailing Address - Phone:360-757-0027
Mailing Address - Fax:360-757-3698
Practice Address - Street 1:712 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2212
Practice Address - Country:US
Practice Address - Phone:360-757-0027
Practice Address - Fax:360-757-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0795810001Medicare NSC
WAAB 40280Medicare UPIN